How did the Broselow tape come about
Dr Jerome LT So
Honorary Treasurer, HKSEMS
It was in 1982. Dr James Broselow was the emergency physician on duty in Lincoln County Hospital, a community hospital in North Carolina in the United States.
Back then emergency medicine was still a young specialty that was just beginning to bloom. And like many peers of his generation, Dr Broselow did not set out to become an emergency physician. He practised family medicine for almost a decade and only came to discover his passion in emergency medicine when he started doing locum work in the emergency department. He enjoyed the work so much that he decided to close his family medicine practice and became a full-time emergency physician in 1980.
For Dr Broselow, the transition from family medicine to emergency medicine was relatively straightforward. It did not take long before he honed his skills in managing adult emergencies. But it is an entirely different animal when it comes to treating an acutely ill or injured child.
A mother suddenly rushed through the door of the emergency department and handed Dr Broselow her infant child, who was cyanotic and non-breathing. He was overwhelmed with emotions. “It was difficult for me to control my thoughts and emotions when a child’s life was a stake”, Dr Broselow recalled, “all the preparation, planning, memorisation and practice in the world cannot fully prepare you for that moment.”
At that time there was no system to estimate body weight of children or to calculate medication dosage, equipment sizes and ventilator settings. The lack of system confounded even the most dedicated of healthcare professionals in such high-stake and high-stress events. It was simply a recipe for disaster. Dr Broselow realised that he needed a more objective system that he can lean on when dealing with sick children.
The encounter spurred Dr Broselow to come up with the idea of an emergency reference tape could be used both as a weight estimation tool and an emergency drug and equipment guide to “take the math out of the medicine”. He further teamed up with Dr Robert Luten and developed a colour coding system to reduce clutter in the tape and facilitate communication. It did not take long before the Broselow tape began to take off, and the rest is history.
The Broselow tape has transformed the standard of emergency care for children and is now a permanent fixture in emergency departments across the world. In recent years, there has been some debates about the accuracy of the Broselow tape, which may underestimate body weight of children in high-income countries and overestimate body weight of children in low and middle-income countries. But overall, the Broselow tape remains the best system of weight estimation and emergency drugs and equipment reference for children in the emergency department.
Dr Broselow is rightfully proud of his tape, but he insisted this was not just for himself. The success of the Broselow tape indicated the maturation of the field of emergency medicine – and its capability of making unique contributions to the house of medicine.
Broselow J. From humble beginnings: the birth of the Broselow tape. 2012. https://epmonthly.com/article/from-humble-beginnings-the-birth-of-the-broselow-tape/.
Wells M, Goldstein LN, Bentley A, et al. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide – A systematic review and meta-analysis. Resuscitation 2017;121:9-33. doi: 10.1016/j.resuscitation.2017.09.026